Work Comp FAQs

Information for workers' comp community.

State Compensation Insurance Fund

Per a representative, State Compensation Insurance Fund (SCIF) unveiled a “new program” with regard to billed Evaluation and Management codes (CPT codes 99201 – 99205 for new patients; 99211 – 99215 for returning patients). If the level of billed E/M service is not supported by the supporting documentation, the E/M code will now be denied and $0 will be sent as payment.

Frequently Asked Questions

Q: I received an incorrect denial from SCIF for an incorrectly downcoded E/M code. Can I still submit a Second Review?

A: Yes. If the CPT was paid at a lower rate than documented in the provided medical records, we recommend that you file a Second Review.

Q: How do I determine the correct level of E/M code and documentation?